A 6205: Simplifies the procedure by which injured workers obtain treatment for injuries covered by the workers' compensation law; provides that the list of pre-authorized procedures is to be used only as a list of treatment that does not require insurance carrier approval.

  
  STATE OF NEW YORK ________________________________________________________________________ 6205 2025-2026 Regular Sessions  IN ASSEMBLY February 27, 2025 ___________ Introduced by M. of A. DURSO -- read once and referred to the Committee on Labor AN ACT to amend the workers' compensation law, in relation to simplify- ing the procedure by which injured workers obtain treatment for inju- ries covered by the workers' compensation law The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 5 of section 13-a of the workers' compensation 2 law, as amended by section 8 of part CC of chapter 55 of the laws of 3 2019, is amended to read as follows: 4 (5) No claim for specialist consultations, surgical operations, 5 physiotherapeutic or occupational therapy procedures, x-ray examinations 6 or special diagnostic laboratory tests costing more than one thousand 7 dollars shall be valid and enforceable, as against such employer, unless 8 such special services shall have been authorized by the employer or by 9 the board, or unless such authorization has been unreasonably withheld, 10 or withheld for a period of more than thirty calendar days from receipt 11 of a request for authorization, or unless such special services are 12 required in an emergency, provided, however, that the basis for a denial 13 of such authorization by the employer must be based on a conflicting 14 second opinion rendered by a physician authorized by the board. The 15 board, with the approval of the superintendent of financial services, 16 shall issue and maintain a list of pre-authorized procedures under this 17 section. Such list of pre-authorized procedures shall be issued and 18 maintained solely for the purpose of expediting authorization of treat- 19 ment of injured workers. Such list of pre-authorized procedures shall 20 not prohibit varied treatment [when the treating provider demonstrates 21 the appropriateness and medical necessity of such treatment], nor shall 22 the list be used as a basis to deny treatment not contained therein. 23 Requests for varied treatment need only comply with the provisions of 24 this subdivision. 25 § 2. This act shall take effect immediately. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01207-01-5